Provider Demographics
NPI:1235148784
Name:KVIEN, WILLIAM K (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:KVIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 EASY ST
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2117
Mailing Address - Country:US
Mailing Address - Phone:928-289-0157
Mailing Address - Fax:
Practice Address - Street 1:1501 N WILLIAMSON AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2735
Practice Address - Country:US
Practice Address - Phone:928-289-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15772207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18478904Medicaid